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Fomepizole in the treatment of ethylene glycol poisoning

Published online by Cambridge University Press:  21 May 2015

Tammy L. Hall
Tammy L. Hall*
Affiliation:
Emergency Medicine, Pharmacy Department, The Ottawa Hospital — Civic Campus, Ottawa, Ont.

Abstract

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The management of ethylene glycol poisoning is reviewed, with a focus on the use of the new antidote fomepizole. Ethylene glycol is a widely used industrial agent that is also easily obtained commercially, usually as radiator antifreeze. Ingestion of as little as 30 to 60 mL can result in death or serious permanent disability. Traditional management of poisoning includes the use of ethanol, with or without hemodialysis. Activated charcoal is not indicated, and gastric lavage may be beneficial only in the first hour after ingestion. Cofactors such as pyridoxine and thiamine may be beneficial in patients deficient in these vitamins. A new antidote, fomepizole, has recently been approved for use in Canada. Like ethanol, it is a competitive inhibitor of alcohol dehydrogenase. Potential benefits of fomepizole include its ease of administration and lack of serious adverse effects. Fomepizole may be recommended over ethanol in situations in which avoidance of ethanol-induced side effects is imperative or when ethanol is not readily available. Further studies are required to verify its comparative efficacy and cost-effectiveness compared to ethanol.

Keywords

adverse effectsantidotescofactorscostethanolethylene glycolfomepizolegut decontaminationhemodialysislevelsoverdose
Type
Toxicology • Toxicologie
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 3 , May 2002 , pp. 199 - 204
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

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